Key result
Cross-sectional imaging matches CYP11B2 IHC in only ~53% of cases, cautioning against imaging-guided targeted therapy.
Why the study?
AVS is standard of care for guiding surgery in primary aldosteronism, but due to technical complexity and limited availability, many centers still use cross-sectional imaging.
Does cross-sectional imaging accurately correspond with CYP11B2 immunohistochemistry in identifying aldosterone sources in patients with lateralized primary aldosteronism?
Cohort (n=173)
Blinded
No
Does cross-sectional imaging accurately correspond with CYP11B2 immunohistochemistry in identifying aldosterone sources in patients with lateralized primary aldosteronism?
Cross-sectional imaging findings correspond with immunohistochemistry mapping of aldosterone sources in only about half of lateralized primary aldosteronism cases, cautioning against relying solely on imaging for targeted therapy.
Answers are grounded in this paper and cite their sources.
Imaging alone may not accurately identify aldosterone sources in PA; leaves open need for IHC validation before targeted therapy.
CONTEXT: Adrenal vein sampling (AVS) is the standard of care for guiding surgery in primary aldosteronism (PA). Because of its technical complexity and limited availability, however, many centers still use cross-sectional imaging for surgical guidance. DESIGN: Single referral-center retrospective cohort study of patients with PA who underwent unilateral adrenalectomy between 2012-2024. Blinded cross-sectional imaging interpretation was corroborated with CYP11B2 immunohistochemistry (IHC) of formalin-fixed paraffin-embedded adrenal tissue. RESULTS: Of 173 patients, age 52.6±11.8 years, 119 (68.8%) were men, 134 (77.5%) White, 30 (17.3%) Black, and 9 (5.2%) other races. CYP11B2 IHC identified a single aldosterone-producing adenoma (APA) or nodule (APN) in 87 (50.3%) and 38 (22.0%) patients, respectively; multiple CYP11B2-positive foci in 45 (26.0%) patients, and no CYP11B2-positive lesions in 3 patients. A single corresponding APA or APN on both IHC and imaging was found in only 53/173 (31%) patients, and an additional 38/173 (22%) patients also had adrenal thickening. Discrepant IHC-imaging findings were observed in 82 (47.4%) patients, including: 1) additional nodule(s) on imaging (ipsilateral non-functional adenoma, n=21; bilateral nodules, n=29; or contralateral nodule(s), n=6); 2) normal adrenals (n=2) or unilateral adrenal hyperplasia (n=4), but discrete CYP11B2-positive foci on IHC; and 3) corresponding APA/APN on imaging-IHC with additional CYP11B2-positive area(s) (n=20). Patients with IHC-imaging concordance had the highest proportion of women and KCNJ5 mutations, while CACNA1D mutations were most frequent in the discordant group. CONCLUSIONS: Even in patients with lateralized PA, IHC mapping of aldosterone sources corresponded with imaging findings in approximately half of the cases. These data caution against targeted therapy guided by cross-sectional imaging.
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Mermejo et al. (2026) conducted a cohort in Primary aldosteronism (n=173). CYP11B2 immunohistochemistry (IHC) vs. Cross-sectional imaging was evaluated on Concordance between CYP11B2 IHC and cross-sectional imaging. CYP11B2 immunohistochemistry mapping of aldosterone sources corresponded with cross-sectional imaging findings in only 52.6% of cases, cautioning against targeted therapy guided by imaging alone.
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